重庆医学
重慶醫學
중경의학
CHONGQING MEDICAL JOURNAL
2015年
5期
633-635
,共3页
骨颈骨折%股骨头坏死%人工全髋关节置换%内固定
骨頸骨摺%股骨頭壞死%人工全髖關節置換%內固定
골경골절%고골두배사%인공전관관절치환%내고정
femoral neck fracture%femur head necrosis%total hip arthroplasty%internal fixation
目的：探讨人工全髋关节置换术治疗股骨颈骨折内固定术后股骨头缺血性坏死的疗效。方法对泸州医学院附属医院骨与关节外科32例股骨颈骨折内固定术后股骨头缺血性坏死患者行人工全髋关节置换术。患者男18例，女14 例，年龄35～62岁，平均50．6岁，左侧19例，右侧13例。手术后8～26个月确诊为股骨头缺血性坏死，平均17．1个月。人工髋关节置换时间距初次手术时间为15～48个月，平均27．2个月。股骨头缺血性坏死的X线 Ficat分期：Ⅲ期8例，Ⅳ期24例。术前改良Harris评分（40．9±9．8）分。本组患者均采用生物型人工关节。结果术后切口均Ⅰ期愈合。全部患者随访6～48个月，平均28．3个月。末次随访 Harris评分为（90．8±4．4）分，与术前比较差异有统计学意义（P＜0．05）。其中优25例，良5例，可2例，优良率93．8％。术中1例发生假体周围骨折（C型），2例出现股骨近端劈裂骨折，相应处理后骨折均愈合。随访期间未见感染、脱位、假体松动等并发症发生。结论人工髋关节置换术是治疗股骨颈骨折内固定术后股骨头缺血性坏死的有效方法。
目的：探討人工全髖關節置換術治療股骨頸骨摺內固定術後股骨頭缺血性壞死的療效。方法對瀘州醫學院附屬醫院骨與關節外科32例股骨頸骨摺內固定術後股骨頭缺血性壞死患者行人工全髖關節置換術。患者男18例，女14 例，年齡35～62歲，平均50．6歲，左側19例，右側13例。手術後8～26箇月確診為股骨頭缺血性壞死，平均17．1箇月。人工髖關節置換時間距初次手術時間為15～48箇月，平均27．2箇月。股骨頭缺血性壞死的X線 Ficat分期：Ⅲ期8例，Ⅳ期24例。術前改良Harris評分（40．9±9．8）分。本組患者均採用生物型人工關節。結果術後切口均Ⅰ期愈閤。全部患者隨訪6～48箇月，平均28．3箇月。末次隨訪 Harris評分為（90．8±4．4）分，與術前比較差異有統計學意義（P＜0．05）。其中優25例，良5例，可2例，優良率93．8％。術中1例髮生假體週圍骨摺（C型），2例齣現股骨近耑劈裂骨摺，相應處理後骨摺均愈閤。隨訪期間未見感染、脫位、假體鬆動等併髮癥髮生。結論人工髖關節置換術是治療股骨頸骨摺內固定術後股骨頭缺血性壞死的有效方法。
목적：탐토인공전관관절치환술치료고골경골절내고정술후고골두결혈성배사적료효。방법대로주의학원부속의원골여관절외과32례고골경골절내고정술후고골두결혈성배사환자행인공전관관절치환술。환자남18례，녀14 례，년령35～62세，평균50．6세，좌측19례，우측13례。수술후8～26개월학진위고골두결혈성배사，평균17．1개월。인공관관절치환시간거초차수술시간위15～48개월，평균27．2개월。고골두결혈성배사적X선 Ficat분기：Ⅲ기8례，Ⅳ기24례。술전개량Harris평분（40．9±9．8）분。본조환자균채용생물형인공관절。결과술후절구균Ⅰ기유합。전부환자수방6～48개월，평균28．3개월。말차수방 Harris평분위（90．8±4．4）분，여술전비교차이유통계학의의（P＜0．05）。기중우25례，량5례，가2례，우량솔93．8％。술중1례발생가체주위골절（C형），2례출현고골근단벽렬골절，상응처리후골절균유합。수방기간미견감염、탈위、가체송동등병발증발생。결론인공관관절치환술시치료고골경골절내고정술후고골두결혈성배사적유효방법。
Objective To explore the therapeutic effect of total hip replacement (T HR) in treating osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture .Methods From January 2003 to June 2012 ,32 cases (19 left hips and 13 right hips) of ONFH after failed internal fixation of femoral neck fracture were treated with THR .There were 18 males and 14 females with an age range from 35 to 62 years (mean ,50 .6 years) .The ONFH was diagnosed at 8-26 months (mean ,17 .1 months) after internal fixation ;the THR were conducted 15-48 months after first surgery (mean ,27 .2 months) .According to Fi‐cat classifi cation ,there were 8 cases at stage Ⅲ and 24 cases at stage IV .The Harris score was (40 .9 ± 9 .8) .The prosthesis of bi‐ology was used .Results All wounds healed by first intention .All cases were followed up for 6-48 months (mean ,28 .3 months) . The Harris score was (90 .8 ± 4 .4) at last follow‐up ,showing significant difference when compared with the preoperative value (P<0 .05) .The hip function were excellent in 25 hips ,good in 5 hips ,fair in 2 hip ,and the excellent and good rate was 93 .8% . There were 1 cases of periprosthetic femoral fracture(type C) ,2 cases of proximal femoral splitting fractures fractures .After corre‐sponding treatment ,fracture was healed in all cases .There were no complications (infection ,loosening dislocation or subsidence , etc) .Conclusion Total hip replacement is an effective method for the treatment of ONFH after failed internal fixation of femoral neck fracture .
